AdvaMed has given the Senate Finance Committee a scaled-down version of legislation to promote remote-monitoring devices that it hopes will be included in a Medicare package being shaped in Congress this year.

The device trade group has been lobbying lawmakers to require CMS to reimburse doctors for time spent analyzing data sent remotely from heart failure, cardiac arrhythmia, diabetes, sleep apnea and epilepsy devices (¹ Also see "Device Industry Looks To SCHIP Bill For Medicare Reforms" - Medtech Insight, 20 August, 2007., p. 4).

The Remote Monitoring Access Act of 2007 (S. 631) was introduced in the Senate in February by Norm Coleman, R-Minn., to address a lack of reimbursement for remote monitoring in order to encourage broader adoption of the technology.

But an independent cost estimate of the original bill, $330 million over five years, is prohibitive. "Recognizing that that cost was probably going to make inclusion of remote monitoring difficult to achieve, AdvaMed and our member companies have worked together to scale back the proposal to increase our chances that we'll be successful," said Julie Cohen, AdvaMed's VP of government relations, at an Oct. 31 briefing.

The trimmed version of the legislation requires national Medicare coverage of remote-monitoring services for heart failure and cardiac arrhythmia, with implementation delayed until 2009. It would also establish a two-year, three-site demonstration project for the remaining three conditions, beginning in 2009. The project calls for about $9 million to cover some 7,500 patients per year.

This version of the legislation would cost about $100 million over five years, according to the private assessment, Cohen said. AdvaMed says it is prioritizing the cardiac conditions because they are the most common and remote-monitoring technologies for those conditions are more mature.

Boston Scientific's Latitude , Medtronic's CareLink and St. Jude Medical's Housecall Plus networks are each set up to transmit device performance and patient symptom data from cardiac rhythm management devices over the Internet to a doctor's computer.

An estimated 185,000 people are on Medtronic's network and physicians have enrolled 70,000 patients on Boston Scientific's Latitude system.

Senate Finance Committee Chairman Max Baucus, D-Mont., and his staff "seem to be very open to the benefits of the technology, not only for managing chronic disease but for the benefits for people living in rural areas," Cohen said.

AdvaMed sent the language to the Congressional Budget Office, which will give its own cost estimate for the proposed reimbursement plan in the next few days. This "score" will ultimately determine whether the provision can be included in the broader Medicare package being crafted.

The Medicare bill is targeted to come up for a vote by the end of the year.

The Oct. 31 briefing accompanied the release of an AdvaMed report on the benefit of remote-monitoring technologies in reducing health care costs for patients with diabetes, heart failure and chronic obstructive pulmonary disease.

AdvaMed cites studies, including several randomized clinical trials, showing remote-monitoring strategies reduced costs and hospitalization time while improving weight control for patients with these chronic ailments.

The Department of Veterans Affairs estimated that about 25,000 veterans received home tele-support for various chronic diseases in fiscal 2006, and projects that number will grow by 50% in 2007. Cost-effectiveness data from the VA program showed remote monitoring reduces annual hospitalization time by about 81%.

"These are tools to be used to enhance and make more valuable the in-person encounter," said the report's lead author Max E. Stachura, M.D., director of the Center for Telehealth, Medical College of Georgia in Augusta. "They can also influence the efficiency with which the health care workforce cares for its patient load."

- Jessica Bylander (j.bylander@elsevier.com)

Industry Presents Scaled-Down Remote-Monitoring Legislation

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